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everett <br />e-., <br />City of Everett L 1 <br />Engineering Department <br />Sewer Application and Permit <br />NO. 10 2 8 2 ✓ DATE <br />Service Addr tss e ( /- L, Utility Account No. — - <br />Billing Address �� .cc� u� lt,A V0 t d Connection Permit Fee --� <br />i <br />City, l,tate, Zip t� -� �i -! ; •� Connection Fee ---- <br />Owner (Mortgagor) i'- i + = Total Fee j <br />Billing Name 1i-+/r- <br />Connection By <br />Address 7 C,�� Ii_S Signed - <br />cwto"r <br />Phone :�y �? - ( ) <br />DESCRIPTION: <br />Lot <br />Block <br />Division or Addition <br />Sewer District <br />z� <br />- Monthly Sewer Service <br />Remarks: t 1 c 7; ; ,N' o <br />Monthly Sewer Constr. <br />a p i <br />/^� Q Approved By •�' - U �i J <br />y � /eG C S ` SS y` , /� - City Engineer <br />D.. GiD J`f i <br />--- Issued By. <br />Connection By <br />Inspection BY <br />Date Inspected LIZ73 / <br />SEE SKETCH ATTACHED <br />